1983年 · 第21卷第06期

Beta-cell function was studied in 24IDD and 20 normal control children by determination of blood glucose, serum insulin and c-peptide after a standard breakfast. Blood glucose, serum insulin and c-peptide levels were elevated significantly in normal children during the test, and reached the peak at 60 minutes. In contrast, the blood glucose of diabetics reached its peak at 120 minutes, and cpeptide level only slightly elevated at 60minutes with a flat curve. Using the detectable c-peptide level (0.05 pmol/ml) as an indication of the presence of residual beta-cell function, 22 diabetics (91.7 % ) had residual function. The result showed the longer the duration of illness the lower the c-peptide levels. When c-peptide peak value increased to 0.10 pmol/ml or more than the fasting level after test meal, it is considered to be responsive. 50% of patients reached this level in this group, with an average peak value approximate to 15.3%that of the normal and an average dura tion of 10.7 months. The remaining pa tients almost displayed no response. How to prolong the residual beta-cell function. in patients retaining it in order to gain sufficient time to favor the treatment is a problem to be further investigated.

LRH and HCG tests were performed in 32 prepubertal boys with bilateral or unilateral cryptorchidism in order to assess their pituitary and gonadal function. Thirty normal boys were examined as controls. We used the RIA matched reagents supplied by WHO, serum levels of LH, FSH and testosterone were determined. The results found to be as follows: (1) The functions of the hypothalamus and pituitary in cryptorchid boys were normal. (2) The endocrinological features of cryptorchidism showed that serum testosterone were lower both in the basal levels and elevated levels set up by reactions than those in normal boys. The basal level of serum FSH were higher than that in normal boys. It suggested the hypofunction of the Leydig cells and Sertoli cells. (3) In prepubertal boys, the hormone levels of unilateral and bilateral cryptorchidism exhibited no sta tistically significant differences (P>0.05).

In this issue we used radioimmunoassay to assess the serum HGH of 43 normal children and 77 children with short stature. The purpose was to establish our children's normal range of the stimulation tests and to appraise the value of these tests in the diagnosis of pituitary dwarfism.

The results showed that-the-determina tion of basal serum HGH could not be used as criteria to assess the secretory function of pituitary HGH, but the stimu lation tests could.A peak HGH value ≥3ng/m1 in any of the stimulation tests (such as exercise, insulin-induced hypoglycemia, L-dopa, and arginine) reflected a normal secretion of the pituitary HGH. The confirmation of HGH deficiency, however, should depend on failure to respond to at least two of the tests.

By comparison we considered the exercise test was the best one of the four stimulation tests. Insulin-induced hypo glycemia test and the L-dopa test came next. Arginine test should be used on those patients who are unsuitable to the insulin-induced hypoglycemia test.

The clinical data of 6 cases with pheochromocytoma in children under 15years of age were presented. Among them 3 cases were 12 years old. The diagnosis was confirmed by pathological findings. The clinical manifestations in children were nearly similar to those in the adults, but the course was usually more severe and rapid. Some patients in this group showed a progressive hypertension associated with cardiac and cerebrovascular damage. Most of the patients were under weight and sometimes shown to have disturbances in growth and development. A good many tumors in this group were bilateral, mul tiple and extraadrenal.

The 24 hour urinary excretion of VMA and catecholamine, the phentolamine test and the retroperitoneal pneumography are useful in diagnosis of the tumour and may be used routinely. A negative retro peritoneal pneumography can not prove non-existence of the tumour.

Surgical removal of the tumour is the treatment of choice. The a-and β-adrenergic receptor blocking agent i. e. phenylbenzamine and propranolol should be administered preoperatively to warrant the smooth progress of operation.

From Janaury 1980 to October 1982, 366 children with purulent meningitis were admitted. Ventricular puncture was done in 33 severe cases and among them 23 were complicated with ventriculitis. Parenteral antibiotic therapy was given routinely for all patients, besides, intraventricular injec tion of antibiotics was used in 18 cases.

5 severe cases on admission suffering from coma, central respiratory failure, cerebral hernia and hydrocephalus finally recovered under the treatment. They were followed up for 3 to 34 months and no sequelae could be found. The indication of ventricular puncture, diagnostic criterion and treatment were discussed.

The above mentioned treatment is considered to be effective for the severe cases of meningitis complicated with ventriculitis. It is suggested that ventricular injection of antibiotics should be done promptly in severe cases as soon as the diagnosis is comfirmed.

The antibody against the liver specific cell membrane lipoprotein (anti-LSP) in serum of 36 cases of viral hepatitis B in children was assayed by SPA-ELISA method, As a result, the rate of anti-LSP positive cases and average titer were apparently higher in the chronic active hepatitis (CAH) (100%, 1: 154.2) than the acute hepatitis (AH) (42.8%, 1: 50.0) and the chronic persistant hepatitis (CPH) (47.6%, 1: 70.7). Follow-up study re vealed that the anti-LSP remained positive in some cases of AH at the end of three months denoting the persistence of the disease and in the cases of CAH the conversion of anti-LSP into negative was slower than that of CPH by the end of six months. It is thus concluded that antiLSP assay might be taken as an assessment of prognosis and activity of the viral hepatitis B. Besides, the relationship between anti-LSP and the liver damage is briefly discussed.

The activity of α-naphthyl acetate esterase of lymphocyte may be regarded as a sign of T lymphocyte if the staining is under strict control. The activity of ANAE of lymphocyte was observed in umbilical blood of 58 normal neonates and peripheral blood of 59 neonates suffering from various diseases. The results showed that in comparing with the normal neonates the activity of the ANAE of lymphocyte including number and activity was increased significantly in the neonates either suffering from bacterial or viral infections especially in viral infection. This test needs only a small amount of blood and is simple and easy to handle or control.

75 cases of tetralogy of Fallot (TOF) in children were studied with M mode and two-dimensional echocardiography. Three items——right pulmonary artery/aortic ar tery ratio (RPA/AO), right/left ventricule ratio (RV/LV) and left ventricular end diastolic volume (LVEDV) from echocar diography——were compared to pulmonary/aortic artery ratio (PA/AO) from open intracardiac surgery. There are significant correlations, r = 0.76, —0.75, 0.75, respec tively (P<0.01). The above three items are considered useful in evaluating the severity of TOF. RPA/AO in TOF measure by echocardiography has not been reported. LVEDV can be used to evaluate the result and prognosis of surgery. If the volume is lower than 66% of normal, low output syndrome will most likely occur after reparative operation.